16-Punkte-Messung - relative Hämoglobin-Konzentration - Verum vs Placebo
7 Anhang
B e f i n d l i c h k e i t s s k a l a
Bf-S´ Bf´
Institution: Station: Datum: Wt:
I-Nr.: ICD-Nr.: Uhrzeit: / Tz:
V-IQ:
--- Ab hier vom Patienten auszufüllen:
Name: Geburtsname:
Vorname: Geburtsdatum: Alter:
Beruf: Geschlecht:
Im folgenden finden Sie eine Reihe von Eigenschaftspaaren. Bitte entscheiden Sie - ohne lange zu über- legen -, welche der beiden Eigenschaften Ihrem augenblicklichen Zustand am ehesten entspricht. Machen Sie in das Kästchen hinter der eher zutreffenden Eigenschaft ein Kreuz. Nur wenn Sie sich gar nicht entscheiden können, machen Sie ein Kreuz in der Spalte „weder - noch“. Lassen Sie keine Zeile aus.
Ich fühle mich jetzt:
eher eher weder - noch
1. aufgeschlossen 0 gehemmt 2 1
2. guter Dinge 0 trübsinnig 2 1
3. antriebslos 2 betriebsam 0 1
4. anfällig 2 robust 0 1
5. zielstrebig 0 ziellos 2 1
6. ernst 2 heiter 0 1
7. einfallsarm 2 einfallsreich 0 1
8. empfindlich 2 unempfindlich 0 1
9. pessimistisch 2 optimistisch 0 1
10. sorglos 0 grüblerisch 2 1
11. zerschlagen 2 munter 0 1
12. liebesfähig 0 liebesunfähig 2 1
13. schuldig 2 unschuldig 0 1
14. erschöpft 2 erholt 0 1
15. lebensmüde 2 lebenslustig 0 1
16. gut 0 böse 2 1
17. fröhlich 0 traurig 2 1
18. geliebt 0 ungeliebt 2 1
19. träge 2 aktiv 0 1
20. verschlossen 2 zugewandt 0 1
21. lebendig 0 leblos 2 1
22. temperamentvoll 0 lahm 2 1
23. aufmerksam 0 zerstreut 2 1
24. verzweifelt 2 hoffnungsvoll 0 1
25. zufrieden 0 unzufrieden 2 1
26. ängstlich 2 draufgängerisch 0 1
27. kraftvoll 0 kraftlos 2 1
28. ausgeglichen 0 rastlos 2 1
B e s c h w e r d e n l i s t e
B-L´ B´
Institution: Station: Datum: Wt:
I-Nr.: ICD-Nr.: Uhrzeit: / Tz:
V-IQ
--- Ab hier vom Patienten auszufüllen:
Name: Geburtsname:
Vorname: Geburtsdatum: Alter:
Beruf: Geschlecht:
Ich leide unter folgenden Beschwerden stark mäßig kaum gar nicht 1. Kopfschmerzen bzw. Druck im Kopf oder Gesichtsschmerzen 3 2 1 0
2. Müdigkeit 3 2 1 0
3. Gleichgewichtsstörungen 3 2 1 0
4. Anfallsweise Atemnot 3 2 1 0
5. Erstickungsgefühl 3 2 1 0
6. Neigung zum Weinen 3 2 1 0
7. Appetitlosigkeit 3 2 1 0
8. Schluckauf 3 2 1 0
9. Herzklopfen, Herzjagen oder Herzstolpern 3 2 1 0
10. Rasche Erschöpfbarkeit 3 2 1 0
11. Angstgefühl 3 2 1 0
12. Leibschmerzen (einschl. Magen- oder Unterleibsschmerzen) 3 2 1 0
13. Verstopfung 3 2 1 0
14. Energielosigkeit 3 2 1 0
15. Gelenk- oder Gliederschmerzen 3 2 1 0
16. Konzentrationsschwäche 3 2 1 0
17. Kalte Füße 3 2 1 0
18. Mangel an geschlechtlicher Erregbarkeit 3 2 1 0
19. Leichtes Erröten 3 2 1 0
20. Frieren 3 2 1 0
21. Aufsteigende Hitze, Hitzewallungen 3 2 1 0
22. Trübe Gedanken 3 2 1 0
23. Innere Gespanntheit 3 2 1 0
24. Taubheitsgefühl („Einschlafen“, „Absterben“, Brennen oder Krib-beln in Händen und/oder Füßen
3 2 1 0
8 A l p h a b e t i s c h e s L i t e r a t u r v e r z e i c h n i s
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